Provider Demographics
NPI:1568446011
Name:LASZCZYK, BOZENA A
Entity Type:Individual
Prefix:
First Name:BOZENA
Middle Name:A
Last Name:LASZCZYK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7115 3RD AVE
Mailing Address - Street 2:APT. 2D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1347
Mailing Address - Country:US
Mailing Address - Phone:718-833-0905
Mailing Address - Fax:718-833-0905
Practice Address - Street 1:3816 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235
Practice Address - Country:US
Practice Address - Phone:718-615-2944
Practice Address - Fax:718-615-2943
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020801225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2331025OtherCIGNA
NY239618OtherWELL CARE
NY9746141OtherGHI
NY020801-NO2OtherHIP
NY2393586OtherUNITED HEALTH CARE
NYQ08Y12Medicare PIN